Provider Demographics
NPI:1487195038
Name:TSB VENTURES, LLC.
Entity Type:Organization
Organization Name:TSB VENTURES, LLC.
Other - Org Name:CUSTOM MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-216-3325
Mailing Address - Street 1:3782 GOLDEN POND DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7748
Mailing Address - Country:US
Mailing Address - Phone:805-216-3325
Mailing Address - Fax:
Practice Address - Street 1:3782 GOLDEN POND DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-7748
Practice Address - Country:US
Practice Address - Phone:805-216-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies